Predictable Rehabilitation of Bone Deficiencies: Hygiene, Functional and Aesthetic Perspectives.

The aim of this article is to describe a method for correcting bone deficiencies which may compromise aesthetic, functional or oral hygiene maintenance of implant supported restorations. The generic causes of these deficiencies are mentioned. The use of autogenous block bone grafts is described alongside methods for managing the hard and soft tissues at both the recipient and donor sites. The biomechanical advantage conferred with the use of grafts in reducing the crown:implant ratio is emphasised. The sources of intraoral bone grafts are identified and the risks of damage to adjacent anatomical structures and their avoidance are addressed.The principles of healing are briefly described with an emphasis on the increasing predictability of contact healing, as opposed to gap healing.The impact and inherent risks associated with the supplementary use of membranes for containment is also addressed.Clinical cases have been used to illustrate procedures and outcomes. Previously published data is referenced.

Clinical utility of epidural volume extension following reduced intrathecal doses: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Epidural Volume Extension (EVE) involves instillation of normal saline into the epidural space soon after an intrathecal injection, with the aim to augment the sensory block height. Its clinical relevance lies in the possibility of using reduced intrathecal dose and yet achieving the desired sensory block level. Intrathecal dose is a known determinant of the level of sensory block. Whether EVE is dependent on intrathecal dose is not known. METHODS: We conducted a randomized, controlled, double-blind study to compare the maximum sensory level (Smax) achieved with or without application of EVE to two different reduced intrathecal doses. Eighty four adult male patients of ASA status I or II with body weight between 50-70kg and height in the range of 150-180cm, scheduled for orthopedic lower limb surgery using combined spinal epidural anesthesia were randomized to receive, either intrathecal dose (5 or 8mg) with or without EVE, in accordance to group allocation. RESULTS: Smax was lowered by application of EVE to 5mg intrathecal bupivacaine (T8.9±4.3 vs. T6.4±1.9 with and without EVE respectively; p = 0.030). Smax was similar when EVE was applied to 8mg intrathecal bupivacaine than without it (T5.8±1.8 vs. T6.4±2.2 respectively; p= 0.324). CONCLUSION: EVE should not be applied to 5mg plain bupivacaine during a combined spinal epidural block in patients undergoing lower limb orthopedic surgery as it may result in a decrease in the maximum sensory level.

Confirmation of placement of endotracheal tube - A comparative observational pilot study of three ultrasound methods.

BACKGROUND AND AIMS: Confirmation of endotracheal tube (ETT) position is necessary to ensure proper ventilation. The present study was conducted with the aim to compare the efficacy of three ultrasonographic (USG) techniques in terms of time taken for confirmation of ETT position. The time taken by each USG technique was also compared with that for auscultation and capnography. The ability of the three USG techniques to identify tracheal placement of ETT was evaluated in all patients. MATERIAL AND METHODS: Ninety adult American Society of Anesthesiologists (ASA) I/II patients requiring general anaesthesia with tracheal intubation were randomised into three groups (n = 30 each) depending upon the initial USG transducer position used to confirm tracheal placement of ETT: group T (tracheal), group P (pleural) and group D (diaphragm). The time taken for confirmation of tracheal placement of ETT by USG, auscultation and capnography was recorded for each of the groups. Subsequently, USG confirmation of ETT placement was performed with the other two USG techniques in all patients. RESULTS: The time taken for USG in group T was significantly less (3.8 ± 0.9 s) compared to group P (12.1 ± 1.6 s) and group D (13.8 ± 1.7 s); P < 0.001. USG was significantly faster than both auscultation and capnography in group T (P < 0.001), whereas in group P and group D, USG took longer time compared to auscultation (P = 0.014 and P < 0.001, respectively) but lesser time than capnography (P < 0.001 in both groups). CONCLUSION: USG is a rapid technique for identification of ETT placement. All the three USG techniques are reliable in identifying the tracheal placement of ETT.

Nonpneumatic Anti-Shock Garment versus Intermittent Sequential Compression Device for Prevention of Postspinal Hypotension in Patients Undergoing Cesarean Section: A Randomized Controlled Study.

CONTEXT: Postspinal hypotension remains a frequent complication of subarachnoid block during cesarean section causing further maternal and fetal adverse effects. AIMS: This study aims to evaluate and compare a continuous pressure nonpneumatic anti-shock garment (NASG) and an intermittent sequential compression device (SCD) with a control group for prevention of postspinal hypotension in women undergoing elective cesarean section. SETTINGS AND DESIGN: A randomized, observer blind, controlled study at single university hospital. SUBJECTS AND METHODS: Ninety singleton term parturients between 18 and 35 years of age undergoing cesarean section with spinal anesthesia were randomly assigned to be applied with NASG, SCD, or no device; n = 30 in each group. A standardized protocol for cohydration and anesthetic technique was followed. The primary outcome measure was incidence of hypotension defined as a decrease in systolic blood pressure of more than 20% from baseline or an absolute value <100 mmHg, whichever was higher. The secondary outcome measures were median dose of ephedrine required, incidence of maternal nausea and vomiting, and neonatal Apgar scores. STATISTICAL ANALYSIS USED: Results were expressed as mean (±standard deviation), median (range), or number (%) as appropriate. Nominal data were compared using Chi-square/Fischer's exact test. Continuous data were compared using ANOVA one-way test. Nonparametric data were compared using Kruskal-Wallis test. RESULTS: In Groups NASG, SCD, and C, incidence of hypotension was 60%, 83%, and 90%, respectively (P = 0.021), with significant reduction in incidence of hypotension in Group NASG versus Group C (P < 0.001, odds ratio 0.17, 95% confidence interval 0.04-0.68). Median (interquartile range) dose of ephedrine required was significantly less in Group NASG compared with Groups SCD and C, respectively (P = 0.002, P < 0.001). CONCLUSIONS: NASG proved to be a more effective device for prevention of postspinal hypotension when compared with application of SCD or no device.

Efficacy of local wound infiltration analgesia with ropivacaine and dexmedetomidine in tubercular spine surgery - A pilot randomised double-blind controlled trial.

BACKGROUND AND AIMS: Regional analgesic techniques are difficult to use in tubercular spine patients due to distorted spinal anatomy and presence of infection. This study was conducted with the aim to evaluate analgesic efficacy of local wound infiltration before wound closure in tubercular spine patients. METHODS: This pilot randomised double-blind controlled study was conducted in 32 American Society of Anesthesiologists I-III patients, age ≥15 years, undergoing elective surgery for spinal tuberculosis. All the patients received general anaesthesia using standard technique and intravenous morphine for intraoperative analgesia. They received wound infiltration with either normal saline (group C) or local infiltration analgesia with 0.375% ropivacaine 3 mg/kg, adrenaline 5 µg/mL and dexmedetomidine 1 µg/kg in a total volume of 0.8 mL/kg (group LIA) before wound closure. Patient-controlled analgesia using intravenous morphine provided postoperative analgesia. The primary objective was to study 24-h morphine consumption, whereas the secondary objectives included pain scores, complications and patient satisfaction. Repeated measures analysis of variance, Chi-square test and Mann-Whitney U test were used for statistical analysis. RESULTS: Morphine requirement was lower in group LIA (6.7 ± 2.7 mg) than in group C (27.7 ± 7.9 mg);P < 0.001. Group LIA also had lower pain scores (P < 0.001), longer time to rescue analgesic (P < 0.001), better patient satisfaction to pain relief (P = 0.001) and lower incidence of postoperative nausea and vomiting than group C. CONCLUSION: Wound infiltration with ropivacaine, adrenaline and dexmedetomidine before wound closure provided good postoperative analgesia with lower morphine requirement.

Risk of early postoperative acute kidney injury with stroke volume variation-guided tetrastarch versus Ringer's lactate.

BACKGROUND: Whether intraoperative use of hydroxyethyl starch (HES) solutions is associated with postoperative acute kidney injury (AKI) continues to be researched. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is validated for early detection of AKI. Previous studies are limited and use empirically predefined volumes of HES solutions with serum creatinine as marker for AKI. MATERIALS AND METHODS: Adults scheduled for orthopedic surgery under general anesthesia with >200-300 mL blood loss expected were included; 40 were randomized to receive 6% HES 130/0.4 (tetrastarch) (group HES) or Ringer's lactate (group RL) boluses when stroke volume variation (SVV) >10% in supine or lateral position, or >14% in prone position. Incidence of early postoperative AKI using urinary NGAL (>100 ng/mL) was the primary outcome, and using derangement of serum creatinine was the secondary measure. RESULTS: In 38 patients, intervention was completed, and incidence of AKI (postoperative urinary NGAL >100 ng/mL) among them was 0% in both groups. Patients with urinary NGAL >50 ng/mL were insignificantly higher for group RL versus group HES (6/19 vs. 4/19) (P = 0.461), as were those with incidence of AKI as per creatinine values (5/19 vs. 4/19) (P = 1.000). Group RL had significantly higher requirement of fluid (1211 ± 758 mL vs. 689 ± 394 mL) (P = 0.013) and lower cardiac index (P < 0.05) versus group HES. CONCLUSION: SVV-guided tetrastarch and Ringer's lactate do not result in postoperative AKI diagnosed by urinary NGAL >100 ng/mL; however, an insignificant trend for better renal functions as well as significantly more efficacious volume expansion and hemodynamic stability were seen with tetrastarch instead.

Low tidal volume ventilation strategy and organ functions in patients with pre-existing systemic inflammatory response.

BACKGROUND AND AIMS: Ventilation can induce increase in inflammatory mediators that may contribute to systemic organ dysfunction. Ventilation-induced organ dysfunction is likely to be accentuated if there is a pre-existing systemic inflammatory response. MATERIAL AND METHODS: Adult patients suffering from intestinal perforation peritonitis-induced systemic inflammatory response syndrome and scheduled for emergency laparotomy were randomized to receive intraoperative ventilation with 10 ml.kg-1 tidal volume (Group H) versus lower tidal volume of 6 ml.kg-1 along with positive end-expiratory pressure (PEEP) of 10 cmH2O (Group L), (n = 45 each). The primary outcome was postoperative organ dysfunction evaluated using the aggregate Sepsis-related Organ Failure Assessment (SOFA) score. The secondary outcomes were, inflammatory mediators viz. interleukin-6, tumor necrosis factor-α, procalcitonin, and C-reactive protein, assessed prior to (basal) and 1 h after initiation of mechanical ventilation, and 18 h postoperatively. RESULTS: The aggregate SOFA score (3[1-3] vs. 1[1-3]); and that on the first postoperative day (2[1-3] vs. 1[0-3]) were higher for group L as compared to group H (P < 0.05). All inflammatory mediators were statistically similar between both groups at all time intervals (P > 0.05). CONCLUSIONS: Mechanical ventilation with low tidal volume of 6 ml/kg-1 along with PEEP of 10 cmH2O is associated with significantly worse postoperative organ functions as compared to high tidal volume of 10 ml.kg-1 in patients of perforation peritonitis-induced systemic inflammation undergoing emergency laparotomy.

Postintubation Sequels: Influence of Fluticasone and Technique of Intra-Operative Muscle Relaxation.

BACKGROUND: Postintubation sequels (PIS) are a cause of serious concern in the postoperative period. AIM: The aim of this study is to find the influence of preoperative inhaled steroid and technique of muscle relaxation on PIS. SETTINGS AND DESIGN: This prospective, exploratory pilot study was conducted on 120 adult American Society of Anesthesiologist physical status Class I and II patients undergoing general anesthesia (GA) with muscle relaxation and cuffed endotracheal tube (ETT) insertion. PATIENTS AND METHODS: Patients were randomized into four groups as follows: intermittent muscle relaxation with preanesthetic inhalation of either distilled water puffs (Group ID) or fluticasone puffs (Group IF); continuous infusion of muscle relaxant with preanesthetic inhalation of either distilled water puffs (Group CD) or fluticasone puffs (Group CF). After induction of GA, ETT was inserted. The intra-cuff pressure was maintained constant. The trachea was extubated in the light plane in intermittent groups and in the deep plane in continuous groups. STATISTICAL ANALYSIS: Qualitative parameters were compared using the Chi-square test and quantitative parameters using repeated measure ANOVA followed by Tukey's test. RESULTS: Group CF had significantly less incidence of sore throat and hoarseness compared to groups ID and IF. The severity of sore throat was more in groups ID and IF than in groups CF and CD (P < 0.002). The severity of hoarseness was least in group CF (23.3%) and highest in group IF (90%). None of the patients had a cough in group CF. The incidence and severity of dysphagia were significantly less in group CF as compared to other groups (P < 0.005 and P < 0.008, respectively). CONCLUSION: Continuous infusion of muscle relaxant with extubation in deep plane of anesthesia with preanesthetic inhalation of fluticasone puffs results in lesser incidence and severity of PIS.

Effect of intravenous phenylephrine infusion on dose requirement of intrathecal plain levobupivacaine for cesarean section: A placebo-controlled preliminary study.

BACKGROUND: Phenylephrine infusion has been shown to decrease rostral spread of plain and hyperbaric local anesthetic (LA) when compared to ephedrine infusion. However, it does not result in higher dose requirement of hyperbaric LA for cesarean section. There is no trial evaluating the effect of phenylephrine infusion on ED50 of a plain intrathecal LA. METHODS: Pregnant patients with term uncomplicated singleton pregnancy undergoing elective cesarean section were given combined spinal-epidural anesthesia. They received intrathecal plain levobupivacaine 0.5% in a dose decided by up-and-down sequential allocation method along with 25 µg fentanyl. Intravenous infusion of phenylephrine (100 µg/ml) or normal saline was initiated immediately after intrathecal injection. Systolic arterial pressure ≤0.8 times baseline was treated using rescue boluses of phenylephrine 50 µg. RESULTS: Demographic, other patient and surgical characteristics were similar in the two groups. ED50 of intrathecal plain levobupivacaine was significantly greater in phenylephrine group (5.5 mg [95% confidence interval (CI): 5.1-5.9 mg]) compared to saline group (4.2 mg [95% CI: 3.4-5.1 mg]) (P = 0.01). Maximum sensory level, time to achieve adequate block, Apgar scores, and umbilical artery pH were similar in both groups. Total phenylephrine dose and patients having significant bradycardia were lesser in the saline group. CONCLUSIONS: Intrathecal dose requirement of plain levobupivacaine is greater using phenylephrine infusion as compared to saline infusion with rescue phenylephrine boluses. When using phenylephrine as a variable dose regimen titrated to maintain blood pressure within 20% of baseline, the ED50 of plain levobupivacaine is 5.5 mg (95% CI: 5.1-5.9 mg).

Effect of thoracic epidural block on infection-induced inflammatory response: A randomized controlled trial.

PURPOSE: Epidural block decreases inflammation and oxidative stress in experimental models of sepsis as well as after surgery. There is, however, no clinical evidence evaluating its effect on infection-induced inflammatory process. The present trial evaluated the effect of thoracic epidural block (TEB) on systemic inflammatory response in patients with small intestinal perforation peritonitis. Outcome measures included systemic levels of interleukin (IL)-6, IL-10, procalcitonin, and C-reactive protein and postoperative Sepsis-Related Organ Failure Assessment scores. MATERIAL AND METHODS: Sixty adult patients undergoing emergency abdominal laparotomy without any contraindication to TEB were randomized to receive general anesthesia alone or in combination with the TEB, which was continued for 48 hours postoperatively (n = 30 each). RESULTS: Use of TEB was associated with a statistically insignificant trend of preservation of anti-inflammatory response depicted by higher levels of IL-10 and lack of alteration in proinflammatory IL-6, along with appreciably lower procalcitonin levels, decreased incidence of raised C-reactive protein levels, and better postoperative SOFA score (P > .05). It resulted in significantly better postoperative respiratory function and faster return of bowel motility (P < .05). Although the sample size is too small for conclusive statement, none of the patients developed epidural abscess. CONCLUSION: Thoracic epidural block showed a trend toward better preservation of anti-inflammatory response and clinical recovery that, however, failed to achieve statistical significance (P > .05).

Immediate Replacement of Single Teeth With Immediately Loaded Implants: Retrospective Analysis of a Clinical Case Series.

INTRODUCTION: The purpose of this retrospective analysis of clinical data was to evaluate the predictability of replacing failing single teeth with immediately placed implants loaded via a transitional (provisional) restoration. MATERIALS AND METHODS: Implants were placed immediately at the time of extraction of failing single teeth that met predetermined inclusion criteria. A detailed protocol was followed to enable immediate loading of the implant with the use of prefabricated abutments in combination with transitional restorations. RESULTS: A total of 375 immediate implants had been placed in 274 patients and loaded immediately. With the certainty of 95%, an estimated overall mean survival rate better than 97.6% was observed after a mean observation period of 36 months. The maximum observation period was 142 months. Four implants had been lost in function. CONCLUSION: Immediate loading of immediately placed implants is a possible treatment option that might be predictably and successfully achieved. Implants of adequate primary stability coupled with a range of prefabricated abutments permit function to be achieved using transitional restorations. The preliminary results of this clinical case series are very promising.

Intrathecal ropivacaine with or without tramadol for lower limb orthopedic surgeries.

BACKGROUND AND AIM: Preservative free tramadol has been used as an adjuvant to intrathecal bupivacaine. However, the effect of the addition of tramadol on intrathecal isobaric ropivacaine has never been studied. MATERIAL AND METHODS: This prospective, randomized, double-blind study was conducted in 50 adult male American Society of Anesthesiologists grade I or II patients, aged 18-60 years, being operated for unilateral femur fractures. An epidural catheter was inserted in L2-L3 interspace and subarachnoid block was given in L3-L4 space. The patients were randomized to receive 0.5 mL normal saline (group R) or 0.5 mL (25 mg) preservative free tramadol (group RT) with 2.5 mL of 0.75% intrathecal ropivacaine. Hemodynamic parameters, sensory level, motor block, sedation and side-effects were recorded. Statistical analysis was done using Student's t-test, Chi-square test, Fischer's exact test and repeated measures ANOVA. RESULTS: The time of sensory block onset was 9.2 ± 4.9 min and 8.6 ± 5.3 min (P = 0.714) in group R and group RT, respectively. The motor block onset was also comparable in both the groups (P = 0.112). The duration of sensory block was 147.2 ± 37.4 min in group R and 160.4 ± 40.9 min in group RT (P = 0.252). The median maximum block height achieved in both the groups was T6 and the time to achieve the maximum block was also comparable statistically (P = 0.301). CONCLUSION: The addition of intrathecal tramadol 25 mg to the isobaric ropivacaine does not alter the block characteristics produced by intrathecal ropivacaine alone.

Efficacy of dexmedetomidine as an adjuvant in paravertebral block in breast cancer surgery.

PURPOSE: This study evaluated the analgesic efficacy of dexmedetomidine in combination with bupivacaine for single-shot paravertebral block (PVB) in patients undergoing major breast cancer surgery. METHODS: This prospective, randomized double blind study was conducted in 45 ASA I/II/III females, aged ≥18 years, undergoing modified radical mastectomy or breast conservation surgery with axillary lymph node dissection. Patients in group PB (paravertebral-bupivacaine) received PVB with 0.5 % bupivacaine 0.3 ml/kg with 1 ml normal saline; group PBD (paravertebral-bupivacaine-dexmedetomidine) received PVB with 0.5 % bupivacaine 0.3 ml/kg and dexmedetomidine 1 µg/kg in a volume of 1 ml; and group C (control) patients were given a sham block (a subcutaneous injection with 2 ml normal saline) before receiving general anesthesia (GA). All patients received analgesia by fentanyl intraoperatively and morphine patient-controlled analgesia postoperatively. RESULTS: The control group patients required more intraoperative fentanyl than the other two groups. Patients receiving dexmedetomidine had lower morphine consumption (p < 0.001), pain scores and incidence of postoperative nausea/vomiting (p = 0.011); longer time to first analgesic request; earlier time to mobilize; and better satisfaction scores. Heart rate and blood pressure values during the intraoperative period were also lower at many time points in this group. However, the incidence of hypotension and bradycardia were statistically similar in all groups. CONCLUSIONS: PVB using dexmedetomidine 1 µg/kg added to 0.5 % bupivacaine in patients undergoing major breast cancer surgery under GA provides analgesia of longer duration with decreased postoperative opioid consumption and lower incidence of nausea/vomiting compared to PVB with bupivacaine alone or no PVB.

Comparison of combitube, easy tube and tracheal tube for general anesthesia.

BACKGROUND & AIMS: The Combitube(®) and EasyTube™ enable effective ventilation whether placed in the trachea or esophagus and can be used in prehospital settings, as well as in "Cannot Ventilate Cannot Intubate" situations in the operating room. Whether they can be continued to provide general anesthesia, if required, is not established. Thus the efficacy of Combitube and EasyTube was evaluated and compared with the tracheal tube for general anesthesia using controlled ventilation. MATERIALS AND METHODS: Combitube, EasyTube and tracheal tubes were used in 30 patients each to secure the airway in a randomized controlled manner. Ventilatory parameters were measured along with hemodynamic variables, and characteristics related to device placement. RESULTS: There was no significant difference in the various ventilatory parameters including minute ventilation requirement to maintain eucapnia amongst the three groups at any time point. There was no hypoxia or hypercarbia in any patient at any time. Placement of EasyTube was more difficult (P = 0.01) as compared with both Combitube and tracheal tube. EasyTube and Combitube resulted in higher incidence of minor trauma than with a tracheal tube (P = 0.00). CONCLUSION: Combitube and EasyTube may be continued for general anesthesia in patients undergoing elective nonlaparoscopic surgeries of moderate duration, if placed for airway maintenance. Given the secondary observations regarding placement characteristics of the airway devices, it, however cannot be concluded that the devices are a substitute for endotracheal tube for airway maintenance per se, unless specifically indicated.

Minimum effective volume of normal saline for epidural volume extension.

BACKGROUND: Rescue strategies like changes in tilt of table are used to raise the level of an inadequate sensory block following intrathecal injection. Epidural volume extension (EVE) refers to an injection of normal saline through epidural catheter following an intrathecal block. It results in a rapid increase in the sensory level of subarachnoid block. Thus, it has been postulated that EVE may be used as a rescue strategy for an inadequate post-spinal sensory block. However, the minimum effective volume (MEV) of normal saline for EVE induced increase in level of spinal block has not been researched till date. We proposed to determine the MEV of normal saline required for EVE induced increase in post-spinal block sensory level. MATERIALS AND METHODS: This prospective sequential allocation study was conducted in consenting adult males after institutional ethical committee approval scheduled for lower limb surgery under combined spinal epidural (CSE) anesthesia, who had an inadequate level of sensory block. Herein, an inadequate level was defined as lower than T10 at 10 min after the intrathecal injection, with no ascent for two consecutive readings taken 2 min apart. The EVE was performed with normal saline injected through epidural catheter, and was considered successful if the level of sensory block increased by two or more dermatomal segments within 5 min of the injection. The volume of normal saline for EVE was decided by using the up-and-down method, with the first patient receiving 10 mL and a dosing interval of 1 mL in subsequent patients. The analysis was done using the formula of Dixon and Massey, which enabled calculation of the MEV with 95% CI. Quantitative parametric data is represented as mean ± SD and nonparametric data as median (range). RESULTS AND CONCLUSION: The MEV of normal saline to raise the level of sensory block by two or more dermatomal segments within 5 min of EVE is 7.4 mL (95% CI: 5.5-9.9 mL).

Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries.

BACKGROUND: In elderly patients, use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in elderly without affecting the side-effects if any of clonidine in these patients. MATERIALS AND METHODS: This was a prospective, randomized, double-blind study. Above 60 years male patients were allocated to three equal groups. Group C received 9 mg hyperbaric bupivacaine without clonidine while Group C15 and Group C30 received 15 µg and 30 µg clonidine with hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. RESULTS: A significantly higher median block levels were achieved in Group C15 (P < 0.001) and Group C30 (P = 0.015) than Group C. Highest median sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically significant between Groups C15 and C and between Groups C30 and C. On comparison of fall in systolic blood pressure trends, there was no significant difference in the clonidine groups as compared with the control group. CONCLUSIONS: In elderly patients, clonidine when used intrathecally in doses of 15 µg or 30 µg with bupivacaine, significantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 µg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

Is midazolam superior to triclofos and hydroxyzine as premedicant in children?

BACKGROUND: Search for an ideal premedicant drug for children is still on. A prospective, randomized trial was conducted to compare the efficacy of midazolam, triclofos and hydroxyzine as premedication in children undergoing lower abdominal surgeries. MATERIALS AND METHODS: Sixty American Society of Anesthesiologists I or II patients 2-8 years of age, scheduled for elective lower abdominal surgery were included. The patients were randomly divided into three groups M, T and H of 20 children each who received midazolam 0.5 mg/kg, triclofos 75 mg/kg and hydroxyzine 0.5 mg/kg respectively, orally 60 min before surgery. The acceptability of drugs, level of sedation, anxiety during separation and on mask application was assessed. RESULTS: The acceptability of midazolam and hydroxyzine was better than triclofos. Hydroxyzine was found to have lesser sedative effect as compared to both midazolam and triclofos. No major adverse effects were observed. CONCLUSION: Midazolam was found to be a better premedicant in terms of sedation, anxiolysis and safety.

Presentation of research in anesthesia: Culmination into publication?

BACKGROUND: To assess the quality of research presentations made in conferences, its success or failure to be published in a peer-reviewed journal is a well-accepted marker. However, there is no data regarding the publication of research presentations made in Indian conferences of anesthesiology. OBJECTIVE: The primary objective was to determine publication rate of research presented at the largest and best attended national conference in anesthesiology, the Indian Society of Anaesthesiologists' Conference (ISACON), and also compare it with the rate from an international conference American Society of Anesthesiologists (ASA annual meeting) held in the same year. MATERIALS AND METHODS: All 363 abstracts presented as poster or podium presentations at the ISACON, and an equal number of randomly selected abstracts presented at ASA annual meeting were searched on Pubmed and Google Scholar for their full-text publications in peer-reviewed journals using a standardized search strategy. As secondary observations, abstracts were assessed for completeness by noting certain components central to research methodology. Also, changes between abstract of the presentation and published paper were noted with respect to certain components. RESULTS: The publication rate of presentations at ISACON and ASA meetings was 5% and 22%, respectively. The abstracts from ISACON lacked central components of research such as methods and statistical tests. The commonest change in the full-text publications as compared with the original abstract from both conferences was a change in authorship. CONCLUSION: Steps are required to augment full-text publication of Indian research, including a more rigorous peer review of abstracts submitted to ISACON to ensure their completeness.